| NPI | 1316940240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WA MD60325837) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: SD 5429) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2015-10-16 |